Application for Admission

Diploma and Certificate Programmes

INSTRUCTIONS: Please complete all sections of this form.

• Answer ALL sections in BLOCK CAPITALS.
• One (1) passport size photograph and a copy of birth certificate should accompany this form.
• Attach all supporting documents with proof of education and training and proof of work experience.
• A non-refundable processing fee of J$1000.00 should be paid.
PLEASE NOTE: PLEASE AFFIX
• A course may be cancelled if there is under-enrolment.
YOUR PHOTO
We encourage you to apply online at www.ucc.edu.jm.
You may also apply by completing and submitting your application form and supporting documents to a UCC Centre or by
mailing them to: Office of the Registrar, The University of the Commonwealth Caribbean, 17 Worthington Avenue, Kingston 5.

Select campus/host school for study:

UCC Main Campus - KINGSTON UCC Centre - OCHO RIOS

UCC Centre - MAYPEN UCC Centre - MONTEGO BAY
UCC Centre - MANDEVILLE UCC Centre - SAVANNA-LA-MAR

SECTION A: Programme | Semester

1 Programme for which you are applying 2 State the semester and the year you intend to commence
your programme
_____________________________________________________
First Option
October ( 20___ )
_____________________________________________________
January ( 20___ )
Second Option

3. Do you have access to high speed internet? No Yes Home Other __________________________________________

SECTION B: Personal Data

1 LAST NAME FIRST NAME MIDDLE NAME

MAIDEN NAME 2 DATE OF BIRTH 3 GENDER

(dd/mm/yyyy)

4 MARITAL STATUS Single Divorced 5 NATIONALITY 6 EMAIL ADDRESS

Married Widowed

7 HOME NUMBER MOBILE NUMBER WORK NUMBER

8 MAILING ADDRESS 9 PERMANENT ADDRESS (if different from mailing address)

9 10 TAXPAYER REGISTRATION NUMBER (TRN):

11. Do you have any physical disabilities? No Yes ( Please state ) __________________________________________

SECTION C: Source of Funding

1 2
What is your source If receiving sponsorship:
of funding? a. Organization: _________________________________________________________________________________
b. Authorising Personel:___________________________________________________________________________
Self
Parent c. Position: _ ____________________________________________________________________________________
Local Loan d. Telephone #: __________________________________________________________________________________
Overseas Loan e. Level of Sponsorship:
Sponsorship
Complete Partial (amount) $ ______________________

Signature: _________________________________________
 SECTION D: Education background
HIGH SCHOOL ATTENDED SUBJECTS PURSUED YEAR AWARD (CXC, O’LEVEL) RESULT

SECTION E: Parent/Guardian Consent

(This is required if you are younger than 18 years of age)

NAME OF PARENT/GUARDIAN RELATIONSHIP TO APPLICANT

ADDRESS

TELEPHONE NUMBER

DATE

SIGNATURE

SECTION F: Applicant’s Declaration

1. My signature certifies that I agree to abide by the policies, rules and regulations of the institution.
2. I also understand that the institution reserves the right to suspend or dismiss any student at anytime for disciplinary misconduct or when
such an action is deemed to be in the best interest of the student and student body.
3. I understand that withholding information requested or falsification of information given will result in the disciplinary action and
make me ineligible for admission and enrollment.

APPLICANT’S SIGNATURE DATE

REFER A FAMILY MEMBER / FRIEND / WORK ASSOCIATE

Please enter their contact information below.

NAME TELEPHONE NUMBER EMAIL ADDRESS

FOR OFFICIAL USE ONLY

Decision: Full Acceptance Denied

Provisional Acceptance Outstanding Requirements: _ ___________________________________________________________________________
Remarks: _________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

NAME OF ADMISSIONS COMMITTEE REPRESENTATIVE SIGNATURE DATE

NAME OF ADMISSIONS OFFICER SIGNATURE DATE

UCCA RECRUITER
NAME ID NUMBER